Summaries of health policy coverage from major news organizations

EMERGENCY MEDICAID: WSJ Examines Immigrant Care

Even though 1996 welfare reforms excluded immigrants, "legal or otherwise," from receiving Medicaid benefits, through Emergency Medicaid, immigrants "are racking up hundreds of thousands of dollars in bills for extravagant care that ordinary Medicaid clients -- or indeed, most insured citizens -- might never be entitled to," the Wall Street Journal reports. Emergency Medicaid generally allows immigrants to receive emergency and trauma care at hospitals, but little else, leaving immigrants "to brave the world without the care they need," the Journal reports. Still, the program's benefits "are potentially without limits," as long as a doctor certifies that a patient needs "acute hospital care," which doctors "are often willing to provide given the grim alternative." Furthermore, hospitals face "tough federal and state antidumping laws" that prevent them from "turning patients away." But because "so many immigrant patients are being stranded in these medical never-never lands," immigrant advocates "have begun throwing up their hands in despair," the Journal reports. Jamaica Hospital social worker Karen Rothman said, "Society says that we can't open up the floodgates, and I understand that, but what do I do? We have a lot of old people, and we give them the medical care, but what should we do with them afterward? We can't send them to a nursing home and we can't send them to rehab." The following situations illustrate the issue:

Six-year-old Shelton Archer swallowed lye "as a toddler in his native country of Guyana," which left him "at death's door unable to swallow and eat and barely able to talk." A "sympathetic" U.S. doctor helped admit Shelton to University Hospital of Brooklyn on a temporary medical visa. After one year of treatment, Shelton is "well enough to go home -- assuming competent in-home nursing care" -- but remains in the hospital because Emergency Medicaid does not cover aftercare and, thus has run up a bill of $606,000, which is picked up by New York, federal taxpayers and the hospital;

An undocumented female immigrant from Zaire was brought to New York's Jamaica hospital nearly two years ago with alcohol- related seizures and dementia. After treatment she "should have been discharged promptly to nursing home care," but she had to remain in the hospital, "taking up space in a $1,000 a day room desperately needed by others." Because Emergency Medicaid does not cover nursing care and the woman's family would not take custody of her, hospital social workers attempted to persuade the Immigration and Naturalization Service to deport her, a move that failed. While searching for a long term care facility that would accept her, the hospital "lost about $500,000" caring for her before finding a facility.

Finding a Solution While no one seems to "have a handle on the nationwide scope of the Emergency Medicaid problem," care providers and officials agree it is "large and growing larger," the Journal reports. An estimated five million undocumented foreign workers are now in the United States. Emergency Medicaid critics maintain that the system "is another example of a misguided U.S. attempt to control ballooning health care costs," the Journal reports. Tim Westmoreland, who oversees Medicaid for HCFA, said, "It is backwards policy for the budgeting of the Medicaid program, for public health, for the individual health of people." For immigrant advocates, a "middle ground" solution might be to attach amendments to Medicaid that would "fill the yawning chasm between Emergency Medicaid and the less expensive needs of such patients." In addition, immigrant advocates support restoring "partial" benefits for immigrants under regular Medicaid. But such a solution "might not be that simple," taking into account "lingering anti-immigrant sentiment and a suspicion by some ... that Emergency Medicaid is popular with many hospitals." Margie McHugh, executive director of the advocacy group the New York Immigration Coalition, said that "there would be much more of an outcry," if hospitals were "really getting hammered," the Journal reports (Lagnado, Wall Street Journal, 10/18).

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